Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
AIAPGET Points
- सर्वस्त्रिदोषोऽधिकदोषलिङ्गैस्तच्छब्दमभ्येति भिषग्जितं च||Cha.Chi.12. All Shothas are caused by Tridoshas but they are named on the basis of predominant dosha involved in the pathogenesis of a particular type of shotha.
- Shvayathu and Shopha are synonyms of Shotha.
- The color of Vataja Shotha is Aruna-Asita. The colour of Pittaja Shotha is Asita-Pita-Raga. The colour of Kaphaja Shotha is Pandu varna.
- Special features of Vataja Shotha – a. Prashamyati Pronnamati Prapidito – Pits on pressure but it quickly rises to the surface & b. Divabali – increases and is prominent during day time
- Special features of Pittaja Shotha – a. Ushyate – Has severe burning sensation, b. Spashta Ruk – clearcut pain & c. Pakavan – tends to suppurate
- Special features of Kaphaja Shotha – a. Krichra Janma Prashamo – this swelling occurs slowly i.e. takes a lot of time to manifest and at the same time takes a lot of time to go away. b. Nipidito Na Cha Unnamed – when pressed the pitting remains for a long time and it takes a lot of time for the pit to disappear and the swelling to come back to the surface – persistent swelling & c. Ratribali – increases and is prominent during night time
Shotha which means swelling or edema, which can either be inflammatory or non-inflammatory in origin has been explained in detail in Ayurveda along with detailed treatment protocol. Shotha can be caused either by aggravated doshas – Ninja Shotha or due to external factors like injury, exposure to toxins or allergens etc – Agantuja Shotha. Ayurveda has explained each of the different types of shotha with their pathogenesis, symptoms and management. But it is very important to identify the cause of swelling or predominant dosha which is causing the shotha. Only then, cause specific and dosha specific treatment can be planned. In this article we will look towards diagnosing shotha on the basis of their dosha predominance.
Note – Shotha is also called SHVAYATHU or SHOPHA.
Identification and Diagnosis of Shotha based on predominant dosha / doshas involved
Shvayathu or Shotha is marked by swelling or edema which appears in the form of utsedha – abnormal elevation of the skin or tissues. While speaking about Nija types of Shotha, they arise due to vitiation of three doshas i.e. vata, pitta and / or kapha. There is often involvement of rakta – blood and sira avarodha i.e. obstruction in circulatory channels / blood vessels of the body. Shotha is undoubtedly caused by the involvement of all the three doshas i.e. vata, pitta and kapha but they are primarily identified and named after the predominant dosha which determines specific group of symptoms in the shvayathu. This classification is the hallmark feature of Ayurveda’s description of diseases and aids in diagnosis and treatment of diseases.
Primary classification of Shotha / Shwayathu from Classical Texts
Most of the major Ayurveda texts, mainly Brihat Trayis have classified Shotha into three main types based on dosha predominance. They are –
Vataja Shotha
This is caused by predominantly aggravated vata.
Symptoms –
– Chala – swelling is movable
– Rough, dry and thin skin,
– Aruna Asita – Golden brown / Dusky-brown or blackish in colour
– Swelling is movable
– The swelling pits on pressure but quickly regains shape (surfaces back)
– Divabali – swelling increases mainly during day time
– Swelling subsides spontaneously
Characteristics of the swelling –
– Swelling is movable
– Prashamyati Pronnamati Prapidito – Pits on pressure but it quickly rises to the surface
– Divabali – increases and is prominent during day time
Associated factors –
– Horripilation / goosebumps
– Numbness
– Discomfort,
– Different kinds of pain,
Pittaja Shotha
This is caused by predominantly aggravated pitta.
Signs and Symptoms –
– Swelling is smooth on touch,
– Has peculiar type of smell – Sagandho
– Has blackish, red or yellow tint
– Rapid onset of swelling
Characteristics of Swelling –
– Hot on touch,
– Ushyate – Has severe burning sensation
– Spashta Ruk – clearcut pain
– Pakavan – tends to suppurate
– Spreads quickly
– Non-pitting or slightly pitting in nature
Associated features –
– Burning sensation
– Raised heat
– Thirst, fever, sweating,
– Giddiness,
– Intoxication
– Akshi Ragakrut – redness of the eyes
Kaphaja Shotha
This is caused by predominantly aggravated kapha.
Signs and Symptoms –
– Swelling is cold,
– Pale or whitish in color
– Smooth
– Skin over swelling is oily
– Presence of heaviness, itching
– Onset of swelling is slow and stable
– Has stiffness
Characteristics of swelling –
– Krichra Janma Prashamo – this swelling occurs slowly i.e. takes lot of time to manifest and at the same time takes lot of time to go away
– Nipidito Na Cha Unnamed – when pressed the pitting remains for long time and it takes lot of time for the pit to disappear and the swelling to come back to the surface – persistent swelling
– Ratribali – increases and is prominent during night time
– Is firm
– Persistent
– Heavy
– Stable
Associated features –
– Excessive salivation,
– Excessive sleep
– Sluggish digestion
Note
Apart from these main doshic types of Shotha, the disease is also manifested due to
– the combination of two doshas – dvidoshaja or samsargaja shotha (example – vata-pittaja shotha, pitta-kaphaja shotha etc) and
– the combination of all three doshas – tridoshaja shotha, which is a severe form of shotha
The symptoms of two or three doshas involved in the pathogenesis of such shothas will be found manifested in mixed proportions.
Other kinds of Shotha are
– Ekanga Shotha – localized swelling and
– Sarvanga Shotha – generalized swelling
As already mentioned, Agantuja Shotha is caused due to external factors like injury, bites of animals etc.
Samhita References and Highlight Points regarding Shotha – Doshic types
-
Charaka Samhita
Ref – Chikitsa Sthana Chapter 12 – Shvayathu Chikitsa Adhyaya & Charaka Sutra Sthana Chapter 18
Important points –
– All shothas involve tridoshas but the naming of each shotha has been done on the basis of predominant dosha involved in causation of shotha
– Detailed symptoms are enumerated in Chapter 12, verse 12 of Chikitsa Sthana
– Vataja Shotha – is rough, dry, dusky, pitting but will quickly recover / Pittaja Shotha – is hot and is burning or has burning sensation / Kaphaja Shotha – is cold, heavy and stable
– Prognosis – Shotha caused by one dosha involvement, of recent origin and manifesting in strong patient is curable
– Treatment principles – The strength of the patient and disease, dosha and season should be assessed. Langhana, Pachana and Shodhana are the main principles of treatment.
-
Sushruta Samhita
Important points –
– Sushruta Samhita emphasizes on discussing Vrana Shotha – inflammatory swellings and Agantuja Shotha – traumatic types
– Sushruta has also classified shotha on dosha predominance with focus on surgical aspects, examples – abscesses and tumours
– The dosha symptoms in doshic shotha align with explanation of Acharya Charaka – Vataja type is rough and movable, Pittaja type is hot and spreading and Kaphaja type is firm and heavy
– The treatise often correlates agantuja shotha i.e. exogenous swellings with abhighataja i.e. those caused due to injury
-
Ashtanga Hrdaya
Important points –
– Follows method of explanation of Acharya Charaka and Sushruta, has mixed excerpts from these texts
– Classification of Shotha has been done as Vataja, Pittaja, Kaphaja etc. with symptoms similar to those explained in Charaka Samhita
– Additional emphasis has been given on the subtypes and combinations of doshas. Treatment of shotha mirrors dosha pacification and dosha-specific approach.
Other texts like Madhava Nidana have followed similar patterns of explaining Shotha as those of Brihat Trayis.
Probable Modern Interpretations and Correlations
Vataja Shotha – often correlates with non-pitting edema. It may be caused due to neurological or cardiac causes like heart failure or peripheral neuropathy. The swelling is fluctuating and has dry skin over and around it.
Pittaja Shotha – can be correlated with inflammatory edema as found in acute infections, liver diseases like hepatitis causing ascites etc.
Kaphaja Shotha – correlates with pitting edema often resulting from renal issues like nephrotic syndrome, hypothyroidism, lymphatic obstruction etc. It presents with fluid retention and heaviness.
Just before finishing
Overall, Shotha can be grossly seen as being caused by fluid imbalance due to dosha vitiation affecting rasa dhatu and channels of circulation (srotas). From the modern viewpoint the doshic types of shotha can be correlated with conditions like congestive heart failure (vata dominant), cirrhosis (pitta dominant) or chronic kidney disease (kapha dominant).
This dosha-based approach towards diagnosis of different kinds of Shotha makes way for personalized identification and management of shotha emphasizing correction of root-causes over symptomatic relief. This will help Ayurveda physicians to properly diagnose and categorize the shothas under the brackets of dosha or doshas involved which is the foundation for comprehensive dosha-specific treatment approaches including selection and administration of herbs, formulations, therapies and dietetic protocols.
